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UpToDate® and Oncology Times are collaborating to present select newly released UpToDate Oncology content synopses, such as the examples below. UpToDate is the premier evidence-based, clinical support resource used by oncology professionals and healthcare practitioners worldwide to make informed clinical decisions at the point of care. Please note that the examples below are accurate as of the month/year indicated next to each topic excerpt. To ensure you are accessing the most current clinical information, subscribe to UpToDate. For a limited time, you can receive an additional 30 days added to an annual or longer personal subscription term when you visit go.uptodate.com/ot30 and enter promo code OT30. This offer is valid through September 30, 2025. Background parenchymal enhancement on breast MRI (July 2025) The accuracy of magnetic resonance imaging (MRI) for breast cancer detection is influenced by background parenchymal enhancement (BPE) but has not previously been quantified. In a systematic review including eight studies in over 6000 females undergoing breast MRI, minimal or mild BPE was associated with higher sensitivity compared with moderate or marked BPE (95% vs. 84%); specificity was also higher (89% vs. 79%).1 On multivariate analysis, moderate or marked BPE was associated with lower diagnostic performance. Despite these limitations, MRI remains a useful strategy to evaluate for breast cancer in selected patients. Fam-trastuzumab deruxtecan for HER2-positive metastatic esophageal and gastric adenocarcinoma (July 2025) For patients with HER2-positive metastatic esophageal and gastric adenocarcinoma who progress on an initial trastuzumab-based regimen, the optimal approach to second-line therapy is not established. In a randomized trial of approximately 500 such patients with HER2-positive metastatic gastric or gastroesophageal junction (GEJ) adenocarcinoma, second-line therapy with fam-trastuzumab deruxtecan improved median overall survival relative to paclitaxel plus ramucirumab (15 vs. 11 months) and was well tolerated.2 For patients with HER2-positive metastatic gastric or GEJ adenocarcinoma who progress on initial trastuzumab-based therapy, we recommend second-line therapy with fam-trastuzumab deruxtecan. Longer-term follow-up of novel strategies in EGFR-positive non-small cell lung cancer (July 2025) Trials are reporting longer-term outcomes of novel strategies in epidermal growth factor receptor (EGFR)-positive advanced non-small cell lung cancer (NSCLC). Previously, a randomized trial had shown improvements in progression-free survival with the addition of chemotherapy to osimertinib. At longer follow-up, there was also a nonsignificant trend toward improvement in overall survival (median not reached vs. 37 months, hazard ratio [HR] 0.75).3 In a separate trial, the combination of the EGFR-MET bispecific antibody amivantamab and third-generation EGFR inhibitor lazertinib has shown overall survival improvements over osimertinib alone (median not reached vs. 37 months, HR 0.75).4 We suggest either osimertinib plus chemotherapy or amivantamab plus lazertinib for EGFR-positive advanced NSCLC, but we consider osimertinib alone to be an acceptable alternative, particularly for those with frailty or low burden of disease. Intravenous magnesium and risk of cisplatin-associated acute kidney injury (June 2025) Acute kidney injury (AKI) is an important complication of cisplatin therapy in patients with cancer; while experimental studies suggest that prophylactic magnesium may reduce the risk of cisplatin-associated AKI (CP-AKI), large clinical trials in humans are lacking. In a recent multicenter cohort study of over 13,000 patients with cancer receiving cisplatin, patients who received prophylactic intravenous (IV) magnesium prior to their first dose of cisplatin had a lower odds of CP-AKI (defined as a twofold or greater rise in serum creatinine or receipt of kidney replacement therapy within 14 days after cisplatin) than those who did not receive magnesium (adjusted odds ratio 0.80, 95% CI: 0.66-0.97).5 These findings suggest that IV magnesium prior to cisplatin therapy may help to prevent CP-AKI; for patients receiving cisplatin, we suggest administering IV isotonic saline supplemented with potassium chloride and magnesium sulfate before and after therapy. Adjuvant atezolizumab plus chemotherapy for resected stage III mismatch repair deficient colon cancer (July 2025) For patients with resected stage III colon cancer that is mismatch repair deficient (dMMR)/microsatellite instability-high (MSI-H), there is interest in combining immunotherapy with chemotherapy in the adjuvant setting to improve outcomes. In a randomized trial in over 700 patients with resected stage III dMMR/MSI-H colon cancer, the addition of atezolizumab to FOLFOX improved 3-year disease-free survival (86% vs. 77%).6 Overall survival results are not yet mature. Based on these data, we suggest adjuvant therapy with atezolizumab plus fluoropyrimidine and oxaliplatin in this population. Disclaimer: This content is provided for reference purposes only and represents a portion of an UpToDate topic. This content is only accurate as of the date it was published. You may not rely on the above content, or any information cited here as being applicable to specific patient circumstances. All topics are continuously updated as new evidence becomes available and subject to our peer-review process. To ensure you are accessing the most current clinical information, subscribe to UpToDate today at go.uptodate.com/ot30 or sign into your existing UpToDate account if you are a current subscriber.